the surgical patient

Question 1

How long before surgery should aspirin be held?

Answer 1

10 days

Question 2

Should anti-hypertensives be held before surgery?

Answer 2

Generally, cont anti-HTN drugs except for diuretics and possibly ACE-I’s

Question 3

What type of valvular disease increases mortality in surgery?

Answer 3

Aortic stenosis (when 50 mm Hg)

Question 4

What might be a possible endocarditis ppx regimen for MVP or prosthetic valves?

Answer 4

30 min before incision: ampicillin and gentamicin. 6 hrs after incision: amoxicillin, or 2nd dose of amp/genta

Question 5

How do SCDs work?

Answer 5

Stimulate endothelial cell fibrinolytic activity. So still works if one leg is injured and can only have one SCD on!

Question 6

What should DM patients do with meds day of surgery?

Answer 6

Discontinue oral hypoglycemics the night before. Take 1/2 dose or entirely hold insulin the day of surgery.

Question 7

What is the classification system for surgical risk for patients with ascites?

Answer 7

Child’s classification (A, B, C)

Question 8

In what order does the GI system “wake up” after surgery?

Answer 8

Small intestine, then stomach, then colon

Question 9

How to estimate when bowel function will return?

Answer 9

Roughly one POD per decade for major abdominal surgery

Question 10

One unit of platelets is expected to raise platelet count by..?

Answer 10

5 to 10,000

Question 11

What to do with patients on warfarin?

Answer 11

1) hold for 3 days and restart on POD#2 or 2) admit preop and change to heparin which can be held only a few hours ahead or 3) switch to subq LMWH

Question 12

Should thyroid meds be given on day of surgery?

Answer 12

Given levothyroxine. Hold anti-thyroid meds (e.g. PTU, MMA)

Question 13

When should abx ppx be given for surgeries?

Answer 13

30 min before incision. Again 6 hrs later if surgery is still going.